ABSTRACT
I. INTRODUCTION Hepatic impairment resulting from the use of conventional drugs is widely acknowledged, but there is less awareness of the potential hepatotoxicity of alternative medicines such as herbal preparations, or vitamins, many of which are believed to be harmless and are commonly used for self-medication without supervision (1-5). There is a return to natural products occurring along with the ecological movement in industrialized countries, and patients are sometimes faced with new diseases with severe complications for which there is still no satisfying treatment, for instance the human immunodeficiency virus infection. Liver injury, including acute and chronic abnormalities and even cirrhotic transformation and liver failure, has been described after the ingestion of a wide range of herbal products and other botanical ingredients, such as mushrooms (6-11), and also from self-medication with vitamin A (12,13). A control of “natural” medicine utilization is appearing in many countries. Marketing authorization is given for plants considered efficient and innocuous. In most cases, the efficiency and safety are based more on a reputation acquired over centuries than on controlled trials and toxicity studies (11). There is another concern with natural botanical hepatotoxins, which comprise a wide range of agents that include fungal toxins (e.g., aflatoxin) and food-derived estrogens (3,4). This chapter summarizes the main
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herbal remedies and mushrooms known to be hepatotoxic, and also discusses vitamin A and botanical hepatotoxins.
